Demystifying Medicine One Week at a Time

A thousand or more cups of urine arrive most nights by express mail to Comprehensive Pain Specialists clinics. The samples are tested for narcotics and other drugs, both legal and illegal. (Heidi de Marco/KHN)

In a beautifully reported investigative piece, Fred Schulte and Elizabeth Lucas of Kaiser Health News detail the explosive growth of the urine drug testing industry in the U.S.

We’ve written about this once before (more than 4 years ago!), but the growth of the industry fueled by taxpayer dollars (Medicare payment for drug testing) appears to be continuing unabated.

In this new piece, Schulte and Lucas do an expose on an outfit called Comprehensive Pain Specialists, a physician-owned outpatient pain management practice with 54 clinics across 10 states in the southeast U.S.

Let me be clear that CPS is not being singled out for malfeasance — rather, the point of the article is that they are emblematic of a huge surge in Medicare spending for expensive urine drug tests — many of which may be unnecessary.

Ay, there’s the rub. From the piece:

…there are virtually no national standards regarding who gets tested, for which drugs and how often. Medicare has spent tens of millions of dollars on tests to detect drugs that presented minimal abuse danger for most patients, according to arguments made by government lawyers in court cases that challenge the standing orders to test patients for drugs. Payments have surged for urine tests for street drugs such as cocaine, PCP and ecstasy, which seldom have been detected in tests done on pain patients. In fact, court records show some of those tests showed up positive just 1 percent of the time.

The other thing that has government watchdogs and other observers worried is that for many pain specialists, the lion’s share of their revenue is earned by these drug tests. Remember, reasons to order these tests are twofold:

Make sure patients ARE taking the drugs that you are prescribing (therefore suggesting that said drugs are not being diverted–e.g. sold on the street).

Make sure patients AREN’T taking drugs of abuse (which for many pain clinics is a violation of the clinic-patient ‘pain management contract’).

As one government attorney was quoted:

“We’re focused on the fact that many physicians are making more money on testing than treating patients,” said Jason Mehta, an assistant U.S. attorney in Jacksonville, Fla. “It is troubling to see providers test everyone for every class of drugs every time they come in.”

The excellent bar graph attached below is included with the KHN story– and clearly demonstrates the trend. What are your thoughts?